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Old 06-01-2009, 09:47 AM
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Default Homans' Sign

Remember Homans' Sign for assessing for DVT? Dorsiflexion of the ankle that reveals calf pain? That's what they teach us in nursing school.

I was doing a lab recently where I didn't do it correctly and received a deserved tongue lashing from my instructor. But, that's what nursing school is for, right?

Determined not to make this mistake again, I've been researching Homans' and had to laugh.

"Homans’ sign is generally
unreliable as a clinical sign of DVT, but it remains
a part of the traditional physical examination of
patients with suspected DVT, perhaps because of its
ease of performing and its historical role in the evaluation
of patients with suspected DVT."

http://www.turner-white.com/pdf/hp_mar01_homan.pdf

Not only that, it's the resistance in the dorsiflexion that is the sign, not calf pain. It is so tempting to go back to that instructor with this information and do a dance while she reads, but I won't.

Wisdom creeps in despite my resistance. What's the general consensus among you folks about Homans'?
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Old 06-01-2009, 10:01 AM
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I use it in HH as a quick rule out type of tool. Never use it in the hospital, we order a d-dimer and if positive a venous doppler.
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Old 06-01-2009, 11:11 AM
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Do use it in HH and Hospice some but we also check for temp, redness, swelling, etc. Then call MD and family to see what they want to do. In the acute care setting we watched for it but did not use Homan's as an indicator. Like DG said, we relied more on doppler and d-dimer than Homan's.
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Old 06-01-2009, 11:22 AM
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I used it in HH, too. I hope nobody ever uses it on me; my right ankle is full of calcium, and the foot can't be dorsiflexed, no matter how hard you try. After they picked up their teeth from the floor, they'd probably put me on clot busters - and Haldol.
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Old 06-01-2009, 11:37 AM
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Thanks guy's. I think the point of my frustration is they aren't even teaching us the right way to do it and what a positive sign truly is. The application was for post partum assessment and, boy, did I catch an earful in front of a bunch of other people. Embarrassing.

Then to find out it's not even a reliable indicator of DVT - ugh. But, I'm venting here instead of with my instructor and that's a good thing.

th_teaLetting it go.
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Old 06-01-2009, 01:20 PM
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I hate to tell you this, Abs; but, it doesn't end after nursing school...

Sometimes I try to imagine what some of these instructors were like on the floor th_leigh1. Then, I get this urge to crawl under a rock and hide forumsmiley1019

I will give you the advise my cousin gave me: "Just jump through the hoops for now"
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Old 06-01-2009, 01:27 PM
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This is one of things that I dread about going back for my RN. Another year of bagdering and getting tongue lashings...lol And I know the bar is even higher for LVN's because they are supposed to know what they are doing.... Well me for one I get nervous and tend to forget alot of things when under pressure. Even stuff I should I should know at the frop of a dime and that should roll right off my tongue.
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Old 06-01-2009, 02:45 PM
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Quote:
Originally Posted by Absolutely13 View Post
Thanks guy's. I think the point of my frustration is they aren't even teaching us the right way to do it .

th_teaLetting it go.

The longer I have been out of school the more I discover, they don't teach you sh#% in nursing school. They only teach you enough to pass your boards. The real learning starts with your orientation.shtnur
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Old 06-01-2009, 03:01 PM
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oh ya my school makes us evaluate using it too. At two of the facilities we go to the staff also does it especially when we did obstetrics. That hospital fired a nurse for skipping that part of the assessment. This hospital has been around a million years & they are infamous in this area for screwing people up.

The place I do my current med surg at will only order a d-dimer if they think the pt is might be having a PE because they can get a false-positive if the pt has had surgery or trauma recently. For whatever reason this one hospital will not order a d-dimer for suspected DVTs. On the other hand the place I go to for pediatrics at will order a d-dimer on a suspected DVT along with using the doppler.

This kind of stuff is another reason why I can't wait to be done with school so I can be oriented to a facility/unit & have some established protocals for stuff. Between school and 2 different rotations at different places I feel crazy trying to remember who does what, where, when & how.
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Old 06-01-2009, 03:04 PM
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Quote:
Originally Posted by momx3lvn View Post
This is one of things that I dread about going back for my RN. Another year of bagdering and getting tongue lashings...lol And I know the bar is even higher for LVN's because they are supposed to know what they are doing.... Well me for one I get nervous and tend to forget alot of things when under pressure. Even stuff I should I should know at the frop of a dime and that should roll right off my tongue.

Tracy we have two LPNs in our class. One of them doesn't tell any clinical instructor that she is already a nurse that way she can get the regular tongue lashings like the rest of us. The other LPN stopped talking at all about 2 semesters into school she was sorry she let anyone know she was already a nurse.
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